ACCOUNT APPLICATION – PUBLIC ORGANIZATION

Goodheart-Willcox Publisher

18604 West Creek Drive ? Tinley Park, IL 60477-6243 g- ? custserv@g-

Orders 1-800-323-0440 Phone 1-708-687-5000

Fax 1-708-468-8692

ACCOUNT APPLICATION ? PUBLIC ORGANIZATION

Name of Organization ______________________________________________________________ Billing Address_______________________________________________________________________ City __________________________________ State ____________ Zip Code ____________________

(_____)________________(_____)_________________ _____________________________________

Telephone

Fax

E-mail ? for emailed invoice

Prepay shipping (included on invoice)

Please use our attached routing instructions

Ship to address (if different from bill to address)______________________________________________

City __________________________________ State ____________ Zip Code ____________________

(_____)________________(_____)_________________ _____________________________________

Telephone

Fax

E-mail

Will purchases be drop shipped? ____Yes ____No If yes into what state(s): ___________________ (Attach sheet if necessary)

Will your purchases be subject to sales/use tax? _____Yes _____No

If no, please provide a current TAX EXEMPTION CERTIFICATE with your completed account application

Accounts Payable Contact:

___________________________________________________________________________________ Name

____________________________ (_____)_____________________

Email

Telephone

The undersigned verifies that the information submitted is true and correct.

___________________________________ __________________________________ __________

Name (Please Print)

Title

Date

___________________________________ Signature

PLEASE RETURN TO: accounting@g-

Goodheart-Willcox Publisher

18604 West Creek Drive ? Tinley Park, IL 60477-6243 g- ? custserv@g-

Orders 1-800-323-0440 Phone 1-708-687-5000

Fax 1-708-687-5068

Below is Goodheart-Willcox Publisher's preferred method of payment:

Please supply this information to your accounts payable department and/or general accounting department

Vendor Information

Federal Employer Identification Number: 36-2135994

E-Mail Address: accounting@g-

Name: Goodheart-Willcox Co, Inc.

Financial Institution Information

Name of Financial Institution: Chase

Address of Financial Institution: 10 S Dearborn Chicago, IL 60603

Representative's Name: Mary Marciniak Routing Number: 071000013

Phone: 312.732.6898 Account Number: 757313882

We also accept credit card and checks via mail: Goodheart-Willcox Publisher ATTN: Accounts Receivable 18604 West Creek Drive Tinley Park, IL 60477

Thank you.

Accounting Department Goodheart-Willcox Publisher

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